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Permit t. :;.. • CITY OF TIGARD MASTER PERMIT • ` �,' : COMMUNITY DEVELOPMENT Permit #: MST2009-00123 1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/14/2009 T� Parcel: 2S11 X601900 Jurisdiction: Tigard Site address: 8056 SW ASHFORD ST Subdivision: ASHFORD OAKS NO. 2 Lot: 33 Project: Jacobs Project Description: Addition and remodel. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 151 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 21 Bathrooms: 0 Second: 116 sf Garage 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors Yes Total: sf Value: $90,000.00 Rear: 0 PLUMBING Sinks' 1 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 2 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures 0 Tubs /Showers: 1 Garbage Disp: 1 Water Heaters: 0 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning N Vent Fans: 1 Clothes Dryers: 0 Heat Pump: N Hoods: 1 Other Units: 0 Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add 500 sf: 0 20 1 -400 amp: 0 201 -400 amp: 0 1st W/O Svc /Fdr: Limited Energy' 401 -600 amp: 0 401 -600 amp: 0 Ea add9 Br Cir: 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) JACOBS, ROLAND L & KIMBERLY TAYLOR MADE CONSTRUCTION & 1 BUP Ersn Cntrl 681 - 4444 M REMODELING 8056 SW ASHFORD ST 3310 FAIRVIEW WY TIGARD, OR 97224 West Linn, OR 97068 PHONE: PHONE: 503 - 913 -6165 FAX: Total Fees: $2,005.46 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. 1 :— Q,`gon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those u -s are - forth in OAR 952 -0 1 -0010 ` hrough OA' 952 -.• -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 / 1.800., 2.2 ^•4. '___-- Issu d ey: £ , I / It /7/ mil Permittee Signature: 9r / - ' Bulkling Permit Application R EE VE D • Residential FOR OFFICE USE ONLY Received 4 � /� �� h /II?' City of Tigard Permit No.: 9 , e •y `� g JUN 0 3 2009 DateB V 13125 SW Hall Blvd., Ti OR 97223 Plan Review' V E C - v/ '""7 Other Permit. Phone: 503.639.4171 Fax: 503.598.1960, - DateB 503.639.4175 W / Inspection Line: �:I O'� Date Ready t y: uris ® See Page 2 for TIGARD g g B U ILDI N G DIVISI I �' / Q� gb J� Supplementallnforma C' v Internet: www.ti and -or. ov Notified/Metho tion La\ C . [- S`tQ ` t A or TYPE OF WORK REQUIRED DATA: WAND AND 2- FAMILY DWELLING . El New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION ' work indicated on this application. El 1- and 2- family dwelling Valuation: $ �D �QQ ❑ Commercial /industrial / ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: &O S j N' 1C j JQ D 5 -,-. - /- New dwelling area: a 47 square feet 1 City /State /ZIP: O AR y0 a 9 7 Z Z ! Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: J A-GG s S Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED. DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. • Add • / 1 �. vt P'1 o0 L Valuation: $ c-/ _ l e ( /C e_ B � c/ ��� J / Existing building area: square feet -I/( New building area: square feet PROPERTY OWNER . ❑ TENANT. Number of stories: Name: Ro L 0 9.- f< f - IA e. 3 S Type of construction: Address: 8 d c 6 S it) /17-4-5_ S'- Occupancy groups: City /State /ZIP: 77 (7 7 2 Z C/ Existing: Phone: (S03) 4020 -- 36 4 2 Fax: ( ) New: ❑ APPLICANT ❑, CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City /State /ZIP: applicant is exempt from licensing, the following reasons • apply: Phone: ( ) Fax::( ) E -mail: CONTRACTOR VD, 1 -V C6 d lL CQ/1JS/ kE G BUILDIG PERMIT F EES Business name: _r IP _ �� !¢. BUILDING FEES* . Address: � 3 /0 f /)_ )/ > u (Please refer to fee ,schedule D0 City/State/ZIP: /,�5 Liyv� Q -74.6,-- Structural plan review fee (or deposit): � b / FLS plan review fee (if applicable): Phone: ( ,-d 3) o 1 3 -6, /,O S Fax: ( ) /6 ? 6 7 / ./. • ( ) Total fees due upon application: I./90 aD Amount received: Authorized signature: L--- This permit application expires if a permit is not obtained ■ within 180 days after it has been accepted as complete. Print name: '�' / S /4 V ©� Date: 6/3/6 ✓ Fee methodology set by Tri -County Building Industry Service Board. I:\Building \Permits\BUP -RES PemritApp.doc 11/6/07 440- 4613T(11/02/COM/WEB) r Building Permit' Application Checklist One- and Two - Family Dwelling FOR OFFICE USE ONLY r City of Tigard Received Permit No.: 114 q 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: : Z Phone: 503.639.4171 Fax: 503.598.1960 Associated permits: 'TIARD ,G 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.tigard - or.gov ❑ Other: THE FOLLOWING' ITEMS ARE REQUIRED FOR PLAN REVIEW Yes N o N/A I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ ❑ 4 Fire district approval required. Name of district: . ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 1 1 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑ - there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ Cl ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑ floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and /or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑ for or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Oregon and shall be shown to be ap a licable to the project under review. • JURISDICTIONAL SPECIFICS 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑ 25 Building plans shall.not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑ ' 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and accompanied by the project arborist's signature of approval. 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ . including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. 1 \ Building \Permits\BUP- RES- PermitApp.doc 03/21/06 440- 4613T(1 1/02 /COM/WEB) Me&anical Permit Application FORIOFFICE USE ONLY - ' � . a City of Tigard °C C j b } \ __ Date y Permit No.: ; 1 SW Hall Blvd., Tigard, OR 9722 Plan Review ,; Phone: 503.639.4171 Fax: 503.598.1960 1, 1 N o 200 /f IGA R Date By Other Permit: D Inspection Line: 503.639.4175 J�+ Date Ready /By: luris ® See Page 2 for Internet: www.tigard - or.gov t ., �IG P Notified/Method: Supplemental Information C ;, r11 \IRS'lOI ' TYPE', OF' WORK ,t '. ` - . COMMERCIAL FEE* SCHEDULE �• USE CHECKLIST El New construction s P, Addition /alteration /replacement Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. .. • CATEGORY OF CONSTRUCTION; ' • : , ' : Value $ : • RESIDENTIAL EQUIPMENT /,SYSTEMS FEES * -:.,x ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total • = , - • JOBS -SITE INFORMATION 'AND LOCATIONS'•. Heating/cooling Job site address: go j S . S � A 5 yd le D ct Air conditioning or heat pump U J (requires site plan showing placement) 14.00 City /State /ZIP: �4o i - R 0 0 7 Z Z Li Furnace 100,000 BTU (ducts /vents) 14.00 Fumace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: Project name: U/ Q J c 0 Is S Gas heat pump 14.00 Cross street/directions to job site: Duct work 2 10.00 Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 14.00 Subdivision: Lot no.: Flue /vent for any of above 6.80 Other: 10.00 Tax map /parcel no.: Other fuel appliances Water heater 10.00 Gas fireplace 10.00 AL /A ) 4 C cl (O '7" Ragil ei QL 2 -- Flue vent for water heater or gas r- fireplace 10.00 Log lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 5 V PROPERTY, OWNER . ' ,'," Chimney /liner /flue /vent 10.00 0 TENANT Other 10.00 Name: Re) L Ailki 10 ,t; t M ��G(.) i S Environmental exhaust and ventilation ,.. 1 / � Range hood /other kitchen Address: (� s c S(�-/ d /�� 7 equipment 1 10.00 City /State /ZIP: % � � , n � 7 Z Z La Clothes dryer exhaust 10.00 G Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) I 6.80 " iAPPLICANT. ` ' , • ...❑ CONTACT 'PERSON. Attic /crawlspace fans 10.00 Other: 10.00 Business name: Fuel t to PP g Contact name: $5.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City /State /ZIP: Wall /suspended/unit heater Fax: ( ) Water heater Phone: ( ) Fireplace E -mail: Range . ,/1 , CONTRACTOR , 4 r.. `'' Barbecue Business name: E.A. to G R. e,„ 6 Clothes dryer (gas) Other: Address: 9 Q , � „ 3 (-'1 ,.,,:MECHANICA ,PERMITFEES *,. ; , City/State /ZIP: U0 L n o C)Q 9706;g Subtotal � V 'C Minimum permit fee ($72.50) f0.. ^� Phone: (3) L-(07 - 9'54_ Fax: ( ) Plan review (25% of permit fee) CCB lie.: i S g' 0 3 1 1 . \ Loci State surcharge (12% of permit fee) =1O TOTAL PERMIT FEE ,� o Authorized si ature: L..-- This permit application expires if a permit is not obtat ed within 180 days after it has been accepted as complete. Print name: / < / / ,,/ v Date: / /C 3 9 . Fee methodology set by Tri- County Building Industry Service Board I: \Buildineermits\MEC-PermitApp doe 01/19/07 f - 4 0 -4617 (I1/02/COM /WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. 1: \Building \Permits \MEC- PermitApp.doc 01/19/07 2 Aug 11 09 10: 33a / _ ao /a P. 2 Electr Permit Applicalip�i, E . FOR IvED OFFICE USE ONLY - 0 City of Tigard Date/By Permit No.. • a 13!25 SW Hall Blvd., Tigard, OR 97/344; y t009 Plan Review Phone: 503,639.4171 Fax: 503.59811'960 Received 1 Date /B': Other Permit: TIGARD Inspection Line: 503.639.4175 Date Ready/By: lads Ei See Page? for Internet: www.tigard -or goy CITY OF TIGARD Notified :Method Supplemental Information TYPE (FI 7 Ui �►ISIJ :.'' PLAN .. PLA. REVIEW ❑ New construction Add 1011 /alle fal1011 /I'Cp {aCemenl Please check all that apply (subunit 2 sets of plans w /items checked below): ['Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Mannas and boatyards. CATEGORY OF CONSTRUCTION ... .. • • exceeds 10,000 amps at 150 volts or ❑ Floating buildings • less to ground, or exceeds 14,000 ❑ Commercial -use agricultural I - and 2- family dwelling ❑ Commerciallindustrial ❑ Accessory building amps for all other installations buildings ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND* LOCATION ❑ Emergency system. larger separately derived system. • : ❑ Addition of new motor load of ❑ "A" "E'.' 1 -_ , I -3 ". Job no.: 1 Li 4 81 Job site address: 8 D 6.*J AS‘■. � tt/0( 64 - I00HP or more. occupancy ❑ � ❑Six or more residential writs. Recreational vehicle parks. City/State/ZIP: ❑ Health - care facilities ❑ Supply voltage for store than 1 1 curd IQ_ J ❑Hazardous locations. 600 molts nominal. Suite /bldg. /apt. no.: Project name: iY i� g ❑ Service or feeder 600 amps or more �—V C J FEE SCHEDULE Cross street /directions to job site: Decripdon I Qty. I Fee. j Total I ' New residential single - or multi - family dwelling unit. Includes attached garage. Subdivision' Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. add'I 500 sq. ft. or portion 33.40 1 Tax map/ parcel no.: Limited energy, residential 75.00 2 • DESCRIPTION OF. WORK = (with above sq. R,) 1' j �Y m C)4. Limited energy, multi- family 75.00 2 e residential (with above sq. fl.) Services or feeders installation, alteration, and /or relocation 200 amps or less 80,30 2 ❑ PROPERTY OWNER, .. ...C3- TENANT';: 201 amps to 400 amps 106.85 2 Name• 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City /Slats /ZIP' Temporary services or feeders installation, alteration, and /or relocation _ Phone: ( ) Fax: ( ) 200 amps or less 66.85 I Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447. 449. 670, and 701. 401 amps to 599 amps 133.75 2 Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Pee for branch circuits with ❑ APPLICANT . • ❑ CONTACT 'PERSON: above service or feeder tee, each branch circuit 6'65 Business name' B. Fee for branch circuits c' Contact name. without service or feeder fee, ' 4685 lit t , DS 2 first branch circuit . Address: Each add'I branch circuit 6.65 iiiiq 2 Miscellaneous (service or feeder not included) City /State /ZIP: Each manufactured or modular 90.90 2 dwelling, service and /or feeder Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 . CONTRACTOR '• • - i . • ' . Sign or outline lighting 53.40 • Business name: �2e�� E ec. -- ( cc, ..�'1 • Signal pa al er li or energy panel, alteration or Address: (5 4000 L- E le Holz. c---r B , extension. Describe: Page 2 2 (( �.1 City /State/ZIP: Each additional inspection over allowable in any of the above I OI G CI�M(.tS, 0 1 1 S Per inspection 62.50 Phone: ( ) r05 b 3 `� Pax: 503) 3) (� Li 1 _ -7 _ Investigation per hour (l hr min) 62.50 CCB Lie,: a lIGAl Electrical L j Suprv. Lic.:rjba 5 Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature. required: .,` P Subtotal: 1,6 Print name: Plan review (25 °.'0 of permit fee): , �, ayi..es j y , ' i 5 • l 6 1 Date: � , State surcharge (12% of permit fee): , 0 I Authorized signature: ($4 r , �� TOTAL PERMIT FEE: - 7 4, o i This permit application expires if a permit is not obtained within 180 Print name: aa /; VII S - Date: g V I I I C1 days after it has been accepted as complete. e/L I * Number of inspections allowed per permit. i..,awii•9n -r o,,,App do:. 05/11i6c 440- 4415T(I 1i05 /COMAVEB , ° • Plambing Permit Application Building Fixtures FOR OFFICE USE ONLY City off Tigard � Received - late/13 ' Permit No • u 13125 SW Hall Blvd., Tigard, OR 97223 RE CEII V E � Plan Review Phone: 503.639.4171 Fax: 503 598.1960 J DateBy. Other Permit No • TIGARD Inspection Line. 503.639.4175 0 3 2009 Date Ready /By tons. ra See Page 2 for Internet. www.tigard Notified/method Notified /Method Supplemental Information CI FY TYPE OF WORK y F I IGARD FEE* SCHEDULE �t.1t1 ?JIl1IU'1 LA VISION ❑ New construction ❑ Demolition For special information use check list Description I Qty. Ea I Total XAddition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 ❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ID Accessory building ❑ Multi - family SPR (3) bath 399 00 ❑Master builder Each additional bath/kitchen 45 00 ❑ Other: Fire sprinkler ( sq ft) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: . 6 S S M � v Catch basin or area drain 16.60 City /State /ZIP: -77 10 /) O' / '7 'Z z Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: ----4_c 6 ,6c Footing drain (no. linear ft.' ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no linear ft.: _) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Lot no.: Water service (no. linear ft . _) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 A ) &.,) ! Jd d / 0 1p k i \- 0 / - L Backwater valve 16.60 Clothes washer 16.60 Dishwasher t I 16.60 ( LA,,,c, PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 O L /4- P `� Ejectors /sump 16.60 Name: /� (/�(�Cd Expansion tank 16.60 Address: Wit 56 S CL) A /../ F _ Q e D S Fixture /sewer cap 16.60 • City /State /ZIP: 17 l tG,AcirZ 0 oa /t q z Z Li Floor drain /floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal I 16.60 ti, (pt's ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State /ZIP: Roof drain (commercial) / 16.60 ( ) Sink/basin/lavatory Mk 16.60 Act ,c,G Phone: ( ) Fax:: !!! Tub /shower /shower pan 16.60 l 6 , E -mail: Urinal 16.60 CONTRACTOR Water closet / - 16 60 I ) , (00 Business name: M /. OLD/4p /it G Water heater 16.60 Address: Other: City /State /ZIP: Subtotal Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 I (6 , j CCB Lie.: 5 0.0 Z Plumbing Lie, no.: Plan review (25% of ermtt fee) State surchargeAwrof permit fee) ( qis, Authorized signature: 'I'O'c TOTAL PERMIT FEE ) .'. ( .4- Print name: J Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. 1 \Bmlding\Permns \PLMP- Perm,tApp doe 12/27/06 440-461 6T( I 0 /02 /COM /WEB) Plumbing Permit Application - City of Tigard • Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160 00 3,601 to 7,200 $220 00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46 40 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46 40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each - Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100 00 or fraction thereof, to (minimum permit fee $36 25) 27.55 and including $25,000 00 Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379 50 for the first $25,000 00 and $1 45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to specially requested inspections - per hour 72 50 and including $50,000.00. Subtotal: $50,001.00 and up $742 00 for the first $50,000.00 and $1 20 for each additional $100 00 or fraction thereof. Fixture Work: Plan Review for Plumbing Installations Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. An accurately report fixtures could result in increased sewer fees *. El new commercial building with water service 2" and Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed Fixture Type: Replace engineer. Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure Baptistry /Font as defined in OAR918- 780 -0040. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040. - Drive Thru Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher - Commercial - Domestic Drinking Fountain Isometric or Riser Diagram Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain /sink - 2" that meet the qualifications above. -3" -4" Car Wash Drain Garbage - Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley *Note: If the fixture work under this permit results in an - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: r \Buildmg\Permits\PLM- Penn0App doe 12/27/06 t 1 . . ......------ . . . . . . - ! 1 0 - - '. ! • I ... (I 1 .: • I 7.4 17.9 'Z6 (---- o p I, i . _______ r _ 1 ____ -."----•---r -L.-- --___._. __________ • ____ • 1 CC>: 0 i 1 . z a m , I- LL Z I '; u) : o I (31 IS ' < z w , 0 . z Lu 0 Eh w , o 0 cc z ce) o E co u _ w o \ 06 III C D? CC er ! cn o Z . co rz NI CD 1 r - >7 L1.1 1111F \ 10 "-"\ - -- -1 7,rilYCLI :a9-- _ __----0-- er; , • -- < ID, ,-.-'-'-'''.......--..--..-.''' • ■ -----------•-•-...... --------- CITY OF TIGARD - SITE PLAN REVIEW __------' \ ' \ BUILDING PERMIT NO.: ‘ /A3 L )._--.1 • ' ', _...------ PLANNING DIVISION: Required Setbacks: ffj Approved Q Not. Approved • • ....-------- = '4 , ' Side 5 Street Side. TO Front. if Garage: - Z.Z Rear: 4 ,--' ..__ Visual Clearance: 9 Approved 0 Not Approved \ \ \\ \ • Maximum Building Height feet CWS Service P ovider Letter Required: 0 Yes 0 No • : UILDING Z OF TIGARD - SITE PLAN REVIEW ' B: . OA/m.4 0 ved J . Date: co/ • ce PERMIT NO: ENGIN ERING DEPARTMENT: • Actual Slope:_i_.% '.;:i Approved • 0 Not Approved Street Trees: i li l lAPProved , a Not Approved I plan: ,,,,_ A ,Approved 0 Not Approved Protectal „Tree : -I Approved CI Not Approved r/D. (r BY:If... i 4 J. tele,or .. Date: Site . it o • . Notes: • Notes: • . .